title: Approaches to prolong the use of uncuffed hemodialysis catheters: results of a randomized trial.
abstract: BACKGROUND
  Use of uncuffed catheters (UCs) in hemodialysis patients is common practice. An antibiotic lock has been recommended to prevent catheter-related bacteremia (CRB), although insufficient data are available about the appropriate antimicrobial agent and dose with prolonged use of UCs.
  
  
  METHODS
  This open-label randomized study was conducted to compare gentamicin/heparin (group A) and taurolidine/citrate (group B), as catheter-lock solutions, in 119 chronic hemodialysis patients in whom a total of 150 UCs were placed. A well-matched historical control group (heparin) included 67 UCs in 58 patients (group C).
  
  
  RESULTS
  CRB episodes developed in 6 and 8 patients in groups A and B, respectively, significantly fewer than in group C (20 patients). Cumulative CRB-free catheter survival at 90 days was 82% for A and 78% for B, which is significantly higher than the 26% for C. Similar Gram-positive infection rates were found in all groups. The Gram-negative infection rate was significantly lower in B compared to C. No significant differences in thrombosis rates were observed between the groups.
  
  
  CONCLUSIONS
  Gentamicin/heparin and taurolidine/citrate, used for locking UC, were similarly effective at preventing CRB and catheter thrombosis for up to 3 months, until a functional permanent vascular access became available. Both antimicrobial lock solutions were superior to heparin in CRB prevention with similar thrombosis rates.
authors.affiliation: Department of Nephrology, Amalia Fleming General Hospital, Athens, Greece. vassilis.filiopoulos@hotmail.com
authors.forename: Vassilis
authors.initials: V
authors.lastname: Filiopoulos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Hadjiyannakos
authors.forename: Ioannis
authors.initials: I
authors.lastname: Koutis
authors.forename: Sofia
authors.initials: S
authors.lastname: Trompouki
authors.forename: Theodora
authors.initials: T
authors.lastname: Micha
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Lazarou
authors.forename: Dimosthenis
authors.initials: D
authors.lastname: Vlassopoulos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D019343:Citric Acid / Q000627:therapeutic use*; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use*; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation; D013654:Taurine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013829:Thiadiazines / Q000627:therapeutic use*
chemical_list: D000890:Anti-Infective Agents; D000925:Anticoagulants; D005839:Gentamicins; D013829:Thiadiazines; D013654:Taurine; D019343:Citric Acid; C012566:taurolidine; D006493:Heparin